Cedars-Sinai Medical Center, Los Angeles, California.
Durham VA Medical Center, Durham, North Carolina.
J Urol. 2022 Feb;207(2):417-423. doi: 10.1097/JU.0000000000002199. Epub 2021 Sep 21.
Benign prostatic hyperplasia (BPH) is a common disease often manifested by lower urinary tract symptoms (LUTS). We previously found statins were associated with modest attenuations in prostate growth over time in REDUCE. We tested whether statins were associated with LUTS incidence in asymptomatic men and LUTS progression in symptomatic men.
We performed a post-hoc analysis of REDUCE in 3,060 "asymptomatic" men with baseline International Prostate Symptom Score (IPSS) <8 and in 2,198 symptomatic men with baseline IPSS ≥8 not taking α-blockers or 5α-reductase inhibitors. We used multivariable Cox regression models to assess associations between statin use at baseline and LUTS incidence and progression. Among asymptomatic men, incident LUTS was defined as the first reported medical or surgical treatment for BPH or sustained clinically significant LUTS (2 reports of IPSS >14). Among symptomatic men, LUTS progression was defined as IPSS increase ≥4 points from baseline, any surgical procedure for BPH, or initiation of a BPH drug.
Among asymptomatic and symptomatic men, 550 (18%) and 392 (18%) used statins at baseline, respectively. On multivariable analysis, statin use was not associated with LUTS incidence (HR 1.05; 95% CI 0.78-1.41, p=0.74) in asymptomatic men, or with LUTS progression (HR 1.13; 95% CI 0.96-1.33, p=0.15) in symptomatic men. Similar results were seen in the dutasteride and placebo arms when stratified by treatment assignment.
In REDUCE, statin use was not associated with either incident LUTS in asymptomatic men or LUTS progression in symptomatic men. These data do not support a role for statins in LUTS prevention or management.
良性前列腺增生（BPH）是一种常见疾病，常表现为下尿路症状（LUTS）。我们之前发现，随着时间的推移，他汀类药物与前列腺生长的适度减弱有关。我们测试了他汀类药物是否与无症状男性的 LUTS 发病率和有症状男性的 LUTS 进展有关。
我们对 REDUCE 中的 3060 名“无症状”男性进行了事后分析，这些男性的基线国际前列腺症状评分（IPSS）<8，以及 2198 名基线 IPSS≥8 的有症状男性，这些男性未服用α受体阻滞剂或 5α-还原酶抑制剂。我们使用多变量 Cox 回归模型来评估基线他汀类药物使用与 LUTS 发病率和进展之间的关系。在无症状男性中，新发 LUTS 定义为首次报告的 BPH 医疗或手术治疗或持续临床显著 LUTS（2 次 IPSS>14）。在有症状男性中，LUTS 进展定义为基线时 IPSS 增加≥4 分、任何 BPH 手术或开始 BPH 药物治疗。
在无症状和有症状的男性中，分别有 550（18%）和 392（18%）名患者在基线时使用了他汀类药物。多变量分析显示，他汀类药物的使用与无症状男性的 LUTS 发病率（HR 1.05；95%CI 0.78-1.41，p=0.74）或有症状男性的 LUTS 进展（HR 1.13；95%CI 0.96-1.33，p=0.15）无关。当按治疗分配分层时，在 dutasteride 和安慰剂组中也观察到了类似的结果。
在 REDUCE 中，他汀类药物的使用与无症状男性新发 LUTS 或有症状男性 LUTS 进展均无关。这些数据不支持他汀类药物在 LUTS 预防或治疗中的作用。
